Provider Demographics
NPI:1497959407
Name:THOMPSON, AMANDA DAWN (BA BHRS)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:DAWN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BA BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 WILSON ST
Mailing Address - Street 2:APT. 219
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3514
Mailing Address - Country:US
Mailing Address - Phone:580-579-0014
Mailing Address - Fax:
Practice Address - Street 1:112 WILSON ST
Practice Address - Street 2:APT. 219
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3514
Practice Address - Country:US
Practice Address - Phone:580-579-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health